导管微波消融兔心外膜和犬心内膜房室环部位对心肌损伤的病理学观察  

Pathologic observation on ventricu iar myocardium of epicardium and focus underneath atrioventricular ring produced by microwave catheter ablation

作　　者：王越红[1] 谷宏越[1] 周立君[1] 石铭宇[1] 李丹阳[2] 黄永麟[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院心血管内科,150001 [2]哈尔滨医科大学第一临床医学院病理科,150001

出　　处：《中国地方病学杂志》2008年第6期636-640,共5页Chinese Jouranl of Endemiology

基　　金：黑龙江省自然科学基金（D9963）

摘　　要：目的通过经导管途径对兔左室心外膜和犬心内膜房室环部位的微波消融，观察微波消融对心肌琥珀酸脱氢酶（SDH）活性的影响及对消融位点心肌组织面积和体积的损伤程度。方法①日本健康大白兔21只，按体质量随机分为10、20、30W组，每组7只。采用20％乌拉坦（4ml／kg）静脉麻醉后暴露心脏，将微波电极轻置于左室前壁心外膜，高压盐水冲注下分别以10、20、30W消融30S。取心室肌，按免疫组化法显示SDH，光镜下观察结果；用千分尺测量损伤范围，计算损伤面积。②健康杂种犬32只，雌雄不限，按体质量分40、50、60、80W组，每组8只，设2个时间点，每个时间点4只。采用戊巴比妥钠，按30mg／kg静脉麻醉，气管插管接呼吸机及心电监护。将消融导管固定于左右心室前／后壁近间隔的房室环处，40、50W组同时消融左右心室前壁，60、80W组同时消融左右心室后壁，消融时间分别60、120S。实验结束后取出心脏，用千分尺测量损伤范围，计算损伤体积，观察是否形成透壁性损伤并进行病理学检查。结果光镜下，消融区SDH活性产物消失，细胞结构不清晰，呈淡蓝色，与周围组织界限清楚。消融中心酶缺损区损伤直径和损伤面积随消融功率（10、20、30W）增加而明显扩大，分别为（3．99±0．41）、（5．20±0．25）、（6．31±0．37）mm和（12．53±2．56）、（21．19±3．14）、（30．96±3．76）mm^3，组间比较差异有统计学意义（F值分别为76．8、58．5,P〈0．01或〈0．05）。犬消融后，光镜下可见损伤区心肌呈凝固性坏死，心内膜可见少量附壁血栓形成。在消融的116个消融点中，发生透壁性损伤16个，有5个损伤累及到肺组织，可见心室穿孔的发生。心肌损伤体积随消融功率（40、50、60、80W）增大而增加，在消融60、120S时损伤体积分别为（46．7±2，5）、（51．1±2．7�Objective To observe the variation of enzymatic activity and areas and bulk of focus of heart injuries by using controllable catheter to ablate epicardial tissue of rabbits and focus underneath atrioventricular ring of dogs. Methods （1） Twenty-one Japanese white rabbits were made into pericardium hammocks after intravenous narcosis with 20% urethane （4 ml/kg） and divided into three groups. Each group included 7 rabbits. Anterior wall epicardium of left ventricle was ablated thirty seconds in each group（10,20 and 30 W） with self-made ablation spheroid microwave antenna, refilling with high pressure normal saline at same time. Then all of the rabbits were sacrificed respectively and their ventricular myocardium were taken out to undergo immunohistochemistry in order to display succinate dehydrogenase （SDH）. Also amplitude was measured in order to calculate areas of heart injuries. （2）With the advantage on maneuverability of left-side radiofrequency catheter （7F）, the long peripheral sheath （8F） was delivered to the pre-selected sites around atrioventricular ring of thirty-two healthy dogs, which had been in intravenous narcosis with pentobarbital sodium（30 mg/kg）. The dogs were divided into four groups （40,50,60 and 80 w） and two time points（60 and 120 s）, by the combined method of X-ray and endocardial electrocardiograph, the microwave antenna could be confirmed to be located at the accurate position between anterior and posterior wall close to septum of left/right ventricle. After ventricular myocardium had been taken out, amplitude were measured in order to calculate bulk of heart injuries by 1/6 × 3.14 × long × wide × deep. In addition, the histological changes and transmural injury were examined by optic microscope. Results In each group, the centre of injuries was enzyme deficiency locus. The diameter and areas of heart injuries enlarged significantly（3.99± 0.41 ）, （5.20 ±0.25）, （6.31 ± 0.37）ram and（12.53 ± 2.56）, （21.19 ± 3.14）, （30.96±

关 键 词：微波 导管消融术 心室 心脏损伤 

分 类 号：R686[医药卫生—骨科学]